Assignment about The Structural and Functional Changes

Question 1 (suggested word limit 400)
Describe the structural and functional changes in the disease process
that led to Jordan’s weight
loss?
The structural and functional changes of the disease process that had led to Jordan
weight loss primarily was contributed by his existing long-term disease of being
diagnosed with Crones disease at a very young age of 17 and the acute increase of
the worsening of the disease itself.Crohns Disease also known as an inflammatory
disease disorder that can affect any part of the digestive tract, this disease does not
have a cure and results in repeated surgical resection and intensive medical
treatment for the patient (Ranasinghe & Hsu, 2019). Crohn's disease is usually
diagnosed between the ages of 15 and 40 (Ha & Khalil, 2015). This disease typically
begins with a small inflammatory apthoid lesion of the mucosa and submucosa of
the bowel. Initial lesions may return or the inflammatory process can progress to all
layers of the bowel wall (TRANSMURAL) hence deeper ulceration ,granulomatous
lesions and fissures (TEARS)develop (Chang et al., 2015).The Lesion appears of like an
inflamed small nodule with a “coble stone “appearance surrounded by ulceration.
Progression of this disease leads to scarring and thickening and decreased flexibility
of the bowel wall which has occurred to Jordan in his case (Fakhoury et al., 2014). There
is an increase of inflammation, oedema and fibrous leading to local obstructions,
abscess formation and fistulas between loops of the bowel and other organs
(Kilcoyne, Kaplan & Gee, 2016).
Thus the progression of the crohns disease develops the Strictures similarly to
an abnormal narrowing of a canal/duct promoting bowel and obstruction in
Jordan terminal ileum. Symptoms associated with this include abdominal
cramping, feeling of fullness, nausea, stomach bloating and more (Rieder et al.,
2013). Jordan has recently being feeling reluctant to eat and drink as per normal
due to him having this type of side effects over the last few weeks which led to
ongoing diarrhoea and vomiting and abdominal pain ,malnutrition and had
contributed to his recent weight loss. Crohns disease can cause diarrhea which
is a leading cause of dehydration in most patients affected which means your
body may be depleted of fluids, nutrients, and necessary electrolytes such as
sodium, potassium, magnesium, phosphorus, and zinc. This can also lead to
weight loss as per Jordan case and his many exacerbations of the disease itself
(Roggero et al., 2009).
Question 2 (suggested word limit 200)
Explain the pain pathway and how Pethidine alters the conscious
perception of pain.
Pain is a complex and highly unpleasant physical sensation caused by an illness or injury
which can be of a very distressing feeling often caused by the intensity itself or the damaging
stimuli (Garland, 2012). Pain also plays a vital physiological role as it acts as the conditioning
stimulus that educate us humans to avoid environmental stimulant that can cause harm. From
a very young age we are told not to touch sharp objects or hot items as in hot drinks, fire etc
because it hurts and as we grow older this sensation helps us to adapt to new and unusual
environments (Yam et al., 2018). There are 4 stages of pain process, transduction
transmission, modulation and perception of pain (Hill, Hall & Glew, 2016) (McEntire et al.,
2016). The Nociceptors are the first order in the pain pathway. Narcotic analgesic is mostly

preferred treatment for moderate to severe pain (Fornasari, 2014). In Jordan’s case he was in
severe pain due to his deteriorating health condition. Narcotics analgesia can change the
desired result to pain, it can also alter the thinking of pain and its response of it.The limbic
system of the brain is associated with emotions and controlling different functions in the
body located deep within your brain, to the hypothalamus, which controls thinking,
behavior and hormonal functions (Sokolowski & Corbin, 2012).

When Delta receptors are activated a feeling of euphoria evolves. Thus, the feeling of well
being may benefit the patient as it diminishes the pain away and assist the person to cope
with their experience of it (Ghelardini, Mannelli & Bianchi, 2015). The opioid ‘pethidine’ is
a synthetic, addictive, narcotic drug, similar to opium or morphine. Opioid analgesic
produces analgesia by binding to the receptors within an outside of the Cns (central
nervous system). Pethidine works my imitate the effects of endorphins (Pathan &
Williams 2012). The nurse must have an understanding of action of Pethidine -both its desired
and undesired effect and correct dosing criteria and adverse effects of the drug prior to
administration of it as per the hospital policy in medication handling and also following the 5
rights of medication administration. (health.nsw.gov.au, 2013)
Question 3
Describe the clinical manifestations that may indicate the
deterioration of Jordan’s Crohn’s disease and explain why these
occur?
Jordan’s condition is deteriorating as of his current symptoms showing ,he has
persistent diarrhoea, loosing water which attributes to his loss of fluids
electrolyte in his body , which also cause imbalances in the body and adds to
weight loss .He has lost good nutrition as his albumin is low ,his also
experiencing nausea and vomiting ,Jordan reluctance to eat and drink may
exacerbate the effects to his body as it could lead to serious dehydration and
malnourishment as per his observations . He is pain and discomfort constantly
and is not getting enough sleep and rest this would also impact his physiology of
his body and be psychology deranged at the same time .Chron ‘s disease means
ulcer of the inner bowel which causes bleeding at times leading to blood
loss .Jordan blood test results of his haemoglobin is 7.9mmol/L under the normal
range .Jordans blood test also showed that his inflammatory markers are high
CRP 30.7mg + ESR 26.55mm this could also provide an indication to why his
temperature on observation was 38.8C,This occurrences are purely related to
the formation of stricture causing bowel obstruction complication of Jordan’s
chronic chrones disease leading to surgery of the affected ileum .
Question 4
Explain the characteristics of the intravenous fluid that was ordered
for Jordan and the rationale for the administration of the IV fluid
relating to Jordan’s specific fluid balance.
Jordan was ordered intravenous fluid by the medical doctor. Hartman’s solution
is an isotonic solution which has the same concentration as plasma. Hartmann
solution contains electrolyte concentrations of K,Na,CI and C are similar to
plasma it expands the intracellular fluid and replaces extracellular fluid losses
and it used in the treatment of hypovolemia .,burns ,fluid lost in the bile or
diarrhea (Coulthard et al., 2012). Jordan’s was showing signs of having fluid loss as
per his physical appearance on observations and his test results ,he had low
bp ,high temperature ,weak peripheral pulses pale dry skin ,poor capillary
fill ,flat neck veins. Jordan haematocrit (Fluid Volume deficit ) reading was high
51%( 35-47%) which could also indicate dehydration .Jordan urine output was of
dark colour concentrated and specific gravity of urinalysis was elevated on
result. Due to Jordan’s condition of unable to eat and drink ,vomiting and
diarrhoea it is difficult for Jordan to take oral hydration at the time of his